Culture matters, especially in medicine

A Latin America Institute symposium finds that culture greatly influences how indigenous communities in Mexico, Central and South America experience Western medicine.

Today, a local Guatemalan medical officer participates in all of UCLA surgeon Reza Jarrahy’s surgical cases, for which the officer oversees post-surgical care, including regular emails to Jarrahy. “He is the future of the project,” said the surgeon.

International Institute, UCLA, March 14—UCLA plastic and reconstructive surgeon Reza Jarrahy began to realize that he was missing something when multiple cases of post-surgical infection began to be reported among his young patients in Guatemala, where he travels to perform pro bono surgeries. It dawned on him, he recounted, that “I don’t know anything about these people.”

Doctors who visit from the United States and offer their services to the local population usually have no appreciation for the cultural context of their patients, Jarrahy explained. By engaging with his patients in their homes, he learned that their families frequently live four to eight people in an 8 x 10–foot shanty with a wood burning stove that spreads soot, and that many children suffer from malnutrition—conditions that can cause post-surgical complications.

Jarrahy subsequently became involved in a program to deliver easy-to-assemble concrete and ceramic stoves to poor indigenous families in Guatemala. These stoves reduce smoke inhalation in their homes, greatly improving both post-surgical conditions and the lifetime pulmonary health of young children. Ultimately he concluded, “To parachute in, operate, and leave is not a sustainable model. It is more important to fly in and build something sustainable that [these patients] can take ownership of.”

Today, a local Guatemalan medical officer participates in all of Jarrahy’s surgical cases, for which the officer oversees post-surgical care, including regular emails to Jarrahy. “He is the future of the project,” said the surgeon, who noted that he finds himself at the crossroads of understanding how his engagement with indigenous people in their homes impacts his work at the local hospital.

Dr. Jarrahy was a participant in the UCLA Latin American Institute (LAI) symposium, “At the Crossroads: Medicine and Culture in Latin America,” held Friday, March 8, at the Charles E. Young Research Library. The symposium was the first of three to be sponsored by the LAI Working Group, “Indigenous Children’s Health in Central and South America” (see below). It brought together specialists from a broad spectrum of disciplines to explore how indigenous communities in Mexico, Central and South America experience Westernized health care, as well as to examine traditional medicine.

Doctors, anthropologists and ethnomusicologists all agreed that culture matters in delivering health care: without accurate cultural understanding, Western medicine can fail miserably. Bonnie Taub, Interim Chair of the UCLA Latin American Studies Graduate Program and on the faculty of both the UCLA Department of Anthropology and the School of Public Health, noted that indigenous peoples in the region bear a disproportionate burden of poverty and its associated epidemiological consequences.

There is an urgent need, Taub argued, for public health programs to address the migration of indigenous peoples from the countryside to “poverty belts” around the cities and the abuse visited on these peoples, including the structural violence of various states against them.

Dr. Oscar Gil-Garcia, a UCLA Chancellor’s Post-Doctoral Fellow in Anthropology, discovered that among forced Guatemalan migrants in La Gloria (Chiapas state), Mexico, two indigenous midwives not only provided pre- and post-natal care to local migrant mothers, they also trained local Mexican women in the profession. Aged 82 and 101 years old when Gil-Garcia met them during four years of research in the town (2004–2007), these midwives had enabled five women to survive childbirth during their flight from Guatemala to the border towns of Mexico in the early 1980s, driven by the scorched-earth policies of the Guatemalan military against indigenous peoples.

Gil-Garcia pointed out that no medical infrastructure existed in Mexico for the medical problems of forced indigenous migrants, who had suffered and continued—via cross-border raids—to suffer enormous brutality and violence at the hands of the Guatemalan military, as well as economic and social marginalization in Mexico.

Traditional midwives, he remarked, responded to the distress of indigenous women in the face of Western medical care, which was often provided by men who did not speak their language and who advocated the use of stirrups instead of the traditional kneeling position that these women used for childbirth.

There is a long history of indigenous care of forced migrants, observed Gil-Garcia. In fact, the outreach of the local Mexican non-profit organization PROSECO into these communities helped the communities win recognition of their own non-profit organization, ensuring them a measure of autonomy in providing health care services to their populations.

Tricia Gabany-Guerrero, Assistant Professor of Anthropology, California State University Fullerton, described the sacred dance for healing practiced by the Purépecha indigenous people in the mountainous village of (Nuevo San Juan) Parangaricutiro, Mexico (state of Michoacán). Working with documents written in Purépecha by indigenous elders over the period 1624–1767, the speaker discovered that the dance was a symbolic petition of an individual to the deity/deities to restore the health of the dancer or a family member.

The dance is practiced with bells on the calves, which are considered the most important site of life force in the body by the Purépecha people. Bells—many of which were discovered in an archeological dig in the region—were made in precise colors and tuned specifically for particular people. The dance for healing continues to this day in the local Templo del Segñor de los Milagros.

With respect to contemporary medical care of the Purépecha, Gabany-Guerrero claimed low-income residents of the community were underserved due to a lack of public clinics. According to local doctor Lupe Espinosa, the cost of Western medicine is a major issue. Only three percent of the population in Parangaricutiro has health insurance from the Mexican state, leaving the majority dependent on private health providers.

Traditional practitioners—herbalists and masseuses who are registered with the Mexican state—are less expensive and preferred by local people. On a positive note, there are few deaths due to childbirth in the town because women’s activism has led pregnant women to plan their deliveries.

Because music frequently plays a role in the healing traditions of indigenous peoples, UCLA Ph.D. candidates in Ethnomusicology Leon F. Garcia Corona, Scott Linford and Jessie Vallejo opened the second half of the symposium with live performances of Central and South American traditional music. They then discussed the roots of this music in indigenous cultures.

Dr. Jennifer Guzmán, a recent UCLA Ph.D. graduate of the Department of Anthropology who now works in the Department of Family Medicine of the UCLA Health System, explored the communication gap between the Mapuche people of Chile and Chilean medical doctors. Western medical practitioners are unaware of the Mapuche healing tradition, she explained, which severely limits the effectiveness of their attempts to help this indigenous community.

At the heart of the miscommunication between the two groups are differing expectations of one another. The Mapuche expect a traditional healer to supernaturally understand an illness by examining a part of a patient’s body or a vital object (e.g., urine, unwashed clothes or even a national ID card), and then inform them of the symptoms. This type of diagnosis is highly valued by the Mapuche. In contrast, Chilean doctors expect patients to describe their symptoms. They themselves generally provide a concise medical diagnosis and complain that Mapuche patients are taciturn, uncooperative, and unable to explain their symptoms.

Guzmán noted that two government initiatives to forge a new era in indigenous relations have largely been symbolic, and that neither bilingual medical signage nor the use of translators has proven effective at clinics. Private hybrid programs that combine medical clinics with traditional healers have been limited by the Mapuche tradition that requires a healer to have a separate space and altar.

Not all indigenous groups have problems mixing traditional beliefs and modern practices. Prof. Bonnie Taub concluded the symposium with a discussion of witchcraft and health among the Zapotec people of Mexico. She described an encounter with an old woman who reported suffering from “soul loss” after not hearing from her children in the United States for two years. The woman explained how her healer had successfully called her soul back into her body, but she continued to mourn her children and suffered from diabetes and gastrointestinal problems.

Taub used such anecdotes to explain how the indigenous people from Oaxaca, Mexico, have survived by fusing traditional health practices with Western medicine. She noted, “They can have dual a diagnosis of susto, or chibih in Zapotec (soul loss)—and they can have a brain tumor.” She pointed out that this odd fusion provides an avenue for researching traditional Zapotec practices that are in danger of disappearing, as well as understanding how these practices intersect with Western medical care.

The Latin American Institute Working Group,“Indigenous Children’s Health in Central and South America,” is funded by a Title VI grant from the U.S. Department of Education and a UCLA Clinical and Translational Science Institute grant (UL1TR000124). Dr. Jarrahy and Professor Taub serve as Co-Principal Investigators of the Working Group; their collaborative vision is to raise awareness of indigenous children’s health issues in the community and across the disciplines of anthropology and medicine.

Taub and Jarrahy, who volunteer for the nonprofit organization Mayan Families, have launched a study in Guatemala that looks at how surgical interventions intersect with people’s beliefs. They recently received a Transdisciplinary Seed Grant from the UCLA Office of the Vice Chancellor for Research, the Academic Senate Council on Research and UCLA Clinical and Translational Science Institute to fund their research. Their project was selected under the health and welfare funding track and is funded under a UCLA Clinical and Translational Science Institute grant (UL1TR000124).